Reflections on the Creation of a Research Agenda for Chiropractic

In July, a workshop was held to develop a research agenda for chiropractic. Interestingly, the effort was initiated by the federal government with a contract to Palmer College of Chiropractic. The amount of money involved was not large, but apparently, it was enough to cause an event like this to happen, something that should have happened in chiropractic many years ago. We should all reflect on this, because it is indicative of the leadership gridlock that has historically affected the development of new knowledge in chiropractic. The dearth of defensible information about chiropractic and chiropractors is still hampering our external ability to integrate successfully with the rest of the so-called health industry.

It is also well to reflect on the kinds of internal arguments chiropractors still have over scope of practice, operational definitions of subluxation, the comparative worth of different chiropractic techniques and procedures, and even the kind of education chiropractors should be receiving. Why are we still having arguments over very basic issues? The answer is that no one side of any argument has enough juice to convince the other. The reason is that there are not enough facts. Facts, in their best form, are generally agreed upon observations. It is a fact that chiropractors exist. How well certain kinds of patients do under chiropractic care is not a fact, because there are arguments about that issue. Some would contend that only patients with musculoskeletal complaints can benefit from chiropractic treatment procedures. Others would argue that many other kinds of complaints are amenable to chiropractic care as well. Some would argue that patients' complaints are irrelevant to chiropractic practice. What is the truth? From a factual point of view, we simply do not know.

The reason we don't know, is because the research has not been done. Let's face it. We have a massive fact deficit in chiropractic. I fear the profession still doesn't realize it, or how dangerous it is to our future. And I say this with full knowledge of the massive strides in research the profession has enjoyed over the past decade. I also say this knowing that the medical profession has many factual sins of its own to clean up. But, their problem does not excuse ours.

As part of the workshop planning, several surveys were conducted. One assessed the research capacity of all chiropractic institutions in North America. The facts from that survey are sobering. For example, only 82 faculty out of 960 have any involvement whatsoever in conducting chiropractic research. Only $4.8 million dollars are spent in chiropractic institutions annually on research. That is only about 2.5% of total dollar expenditures in chiropractic colleges. There are less than 20 faculty (in all of North America), with degrees in highly useful and relevant research disciplines such as biomechanics, health services, biostatistics, and public health. Conclusion, the research capacity of the chiropractic profession is woefully lacking.

Is this the colleges' fault? No, it is everyone's fault. The colleges are still struggling to survive and simply keep teachers employed. Tuition dependency and the lack of other sources of funding that might support research have been severe barriers to the development of facts. But it is a vicious cycle. Lack of research capacity leads to lack of research which leads to lack of funding which leads to lack of research, etc. What do we do to break this cycle? It will only break when enough people in chiropractic think the problem is large enough, compared with other problems.

How can we create a way to ascertain the facts that can settle the basic arguments that plague and divide our profession? I see four major themes that we must address:

• We must develop a culture that rewards people for developing high quality information (facts).

   

• We must develop a psychological context in the profession, that requires facts for decision-making. When there is a perceived need, the market will marshal resources and deliver it.

   

• We must collaborate with individuals and institutions outside of chiropractic to develop the factual capacity that we need.

   

• We must develop the financial resources to initiate the first three themes.

Notwithstanding the advances that chiropractic research has managed, the time has come to reassess our professional commitment, our strategies, and our priorities for the science of chiropractic. The recent workshop to develop the chiropractic research agenda should be only the beginning of a renewed and stronger effort to meet the goals that only high quality, chiropractic-driven research can accomplish for our profession.

I hereby call upon our leaders, our organizations, and our practitioners to grapple and solve this challenge, before it is too late.

William Meeker, DC, MPH, FICC
Davenport, Iowa